Project Summary/Abstract Written The objective of the proposed research is to reduce the patient safety hazards associated with electronic medication administration records (eMARs) by, (1) understanding current usability and safety gaps, and (2) creating design and development documents, wireframes, and prototypes to serve as the foundation for future eMARs that will eliminate these gaps. In particular, we focus on communication and information flow challenges between nurses, pharmacists, and physicians during medication administration and use of the eMAR. The proposed research is in direct response to special emphasis notice (NOT-HS-16-009). We will develop a broad understanding of usability and safety hazards associated with eMARs by analyzing a large dataset of 1.7 million patient safety event reports and detailed medication error related narratives. We will then conduct heuristic analyses of current eMARs, and interviews and observations of physicians, nurses, and pharmacists. These data will serve to inform the development of eMAR design documents, wireframes, and prototypes as the foundation for future development. This project utilizes the extensive expertise of the research team in human factors and safety science, health information technology (health IT), informatics, and data science. Our research team includes physicians, nurses, pharmacists, and human factors engineers, and experts in natural language processing. In addition, our partnerships include a patient safety organization and a health IT vendor. The proposal addresses fundamental aspects of the call for proposals by providing new insights on the safety of health IT and improves current practices by developing use cases and new prototypes for immediate use by healthIT vendors. Contributions from this research will include a fundamental understanding of the role of health IT during medication administration with a focus on communication and information flow, design, development and testing documents for vendors and providers, and eMAR wireframes and prototypes to improve development. Our research will also provide organizations like the Office of the National Coordinator with medication related test scenarios to assess current health IT systems.